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Polymyxin Resistance in Gram-negative Pathogens

Pavithra Srinivas1, Kaitlyn Rivard2

  • 1Department of Pharmacy, Cleveland Clinic, 9500 Euclid Ave (Hb-105), Cleveland, OH, 44195, USA. srinivp2@ccf.org.

Current Infectious Disease Reports
|September 13, 2017
PubMed
Abstract

Insights

Polymyxin resistance in Gram-negative bacteria is increasing, primarily due to lipopolysaccharide modification. Strategies like dose optimization and combination therapy can help overcome this growing challenge.

Area of Science:

  • Microbiology
  • Antimicrobial Resistance
  • Pharmacology

Background:

  • Polymyxins are crucial last-resort antibiotics against multidrug-resistant Gram-negative bacilli.
  • Increasing polymyxin use has led to a rise in reported resistance.
  • Understanding resistance mechanisms is vital for effective treatment strategies.

Purpose of the Study:

  • To elucidate the mechanisms of polymyxin resistance in Gram-negative organisms.
  • To describe the epidemiological occurrence of polymyxin resistance.
  • To propose actionable strategies for overcoming polymyxin resistance.

Main Methods:

  • Review of global epidemiological surveillance studies.
  • Analysis of bacterial outer membrane lipopolysaccharide modification.
  • Evaluation of current and proposed treatment strategies.

Main Results:

  • Acquired polymyxin resistance commonly involves lipopolysaccharide modification.
  • Enterobacteriaceae (Enterobacter spp.) and Acinetobacter baumannii are frequently implicated.
  • Geographical location significantly impacts the prevalence of resistant organisms.

Conclusions:

  • Polymyxin resistance emergence is a significant concern due to limited therapeutic options.
  • Dose optimization and combination antimicrobial therapy are key strategies.
  • Continued surveillance and research are necessary to combat resistance.
Keywords:
Colistimethate sodiumColistinMultidrug-resistant gram-negative bacilliPolymyxin B

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